1552NOTE:,*r
With proper validation Q'
O
t� this form constitutes ano
encroachment permit CITY OF LA QUINTA U
APPLICATION FOR PERMIT
4 PUBLIC -WORKS CONSTRUCTION •(ENCROACHMENT)��
For the construction of public or private curbs, driveways; pavements, sidewalks; parking lots,, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit— Class III
DATE: 9-18-92Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 52-290 Avo Mendbsa �
(Street address or Description of Location)
PURPOSE -OF CONSTRUCTION Ariymmy itorogeh Sketch (attach construction plans if appropriate)-
DESCRIPTION
ppropriate)DESCRIPTION OF CONSTRUCTION per Uvereide Co, _8t4 No. 207
• - �����I;Ilbd
DIMENSION OFANSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
'APPROXIMATE TIME WHEN WORK WILUBEGIN
APPROXIMATE TIME OF COMPLETION 9»2392
ESTIMATED CONSTRUCTION COST $
.(Including removal of all. obstruction, materials, and debris, backfilling, com-
paction and1 placing, permanent resurfacing and/or replacing improvements)
In consideration of -the granting of this permit, the applicant hereby agrees to: "
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from,claims or court action and arising out of any accident, loss or damage to persons or property
' happening or occurring as a proximate result of any ,work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
• '
Comply 'with 'all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
.k
La Quinta and'to pay for. any additional replacement necessary as the result of this work.
• Signature of Applicant or Agent
bemetxio 'Colt s :. , $2-915 Ave #iUajo La QuInt e CA ..92253 564-3424
Name of Applicant (please print) Business Address Telephone No. '
011luo r t uildo ;
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. . City BusinessLicense No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I•I I
,
` a9j8-92 14
` Pul lic'improvements: 3% of estimated construction costs' "( A [ �i>- 30.00
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ 20 PERMIT VALIDATION
Permit Fee PERMIT NO. 1552'
Penalty 9-18-92
Cash Deposit -Surety Bond DATE APPROVED
if required EXPIRATION DATE 9-25-92
TOTAL: 30
Receipt No.
Received by Date
DATE I SUED -18-92
By ,64,
i Administrative Authority
Recorded by TELEPHONE: (619) 564-2246
NOTE:
With proper validation
this form constitutes an .
encroachment permit
CITY ,OF LA OUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or • private curbs, driveways, pavements; sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I II
DATE:f _ Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION 5 Z Z 010 vG- e_
(Street address or Description of Location) /
PURPOSE OF CONSTRUCTION 1 �r���p�A �� [�do al'G, Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGII�,
APPROXIMATE TIME OF COMPLETI
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials,.and debris, backfilling, com-
paction and placing permanent resurfacing and/or. replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and .arising out of .any accident, loss or damage,to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty, -four (24) hours in advance. of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and• regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
of Applicant (please print)
Name of Contractor and Job roreman
Signature of 71-1 t or Agen
J,,,Business Address
. Business Address
Telephone No.
�C
Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
FEES:, . Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
�F,
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $ PERMIT VALIDATION
Permit Fee
PERMIT NO.
Penalty
Cash Deposit -Surety Bond DATE APPROVED
if required
EXPIRATION DATE
TOTAL: $
DATE ISSUED
Receipt No.
By
Received by Date Administrative Authority
Recorded by TELEPHONE: (619) 564-2246